This prospective, cross-sectional, observational study examined associations between sense of coherence (SOC), mental well-being, and perceived preoperative hospital and surgery related stress of surgical patients with malignant, benign, and no neoplasms. The objective was to assess a putative association between SOC and preoperative stress, and to test for a statistical mediation by mental well-being. The sample consisted of 4918 patients from diverse surgical fields, of which 945 had malignant neoplasms, 333 benign neoplasms, and 3640 no neoplasms. For each subsample, we conducted simple mediation analyses to test an indirect effect of SOC on preoperative stress mediated by mental well-being. The models were adjusted for age, gender, and essential medical factors. Patient groups did not differ significantly regarding degrees of SOC and mental well-being (SOC, M [SD]: 12.31 [2.59], 12.02 [2.62], 12.18 [2.57]; mental well-being M [SD]: 59.26 [24.05], 56.89 [22.67], 57.31 [22.87], in patients with malignant, benign, and without neoplasms, respectively). Patients without neoplasms reported significantly lower stress (4.19 [2.86], M [SD]) than those with benign (5.02 [3.03], M [SD]) and malignant neoplasms (4.99 [2.93], M [SD]). In all three mediation models, SOC had significant direct effects on stress, with higher SOC being associated with lower stress (− 0.3170 [0.0407], − 0.3484 [0.0752], − 0.2919 [0.0206]; c’ [SE], p < 0.001 in patients with malignant, benign, and without neoplasms, respectively). In patients with malignant neoplasms and without neoplasms, SOC showed small indirect effects on stress that were statistically mediated by well-being. Higher SOC was related to higher well-being, which in turn was related to lower stress. In patients with benign neoplasms, however, no significant indirect effects of SOC were found. SOC was directly associated with lower perceived hospital and surgery related stress, over and above the direct and mediation effects of mental well-being. Because the data are cross-sectional, conclusions implying causality cannot be drawn. Nevertheless, they indicate important relationships that can inform treatment approaches to reduce elevated preoperative stress by specifically addressing low SOC. clinicaltrials.gov Identifier: NCT01357694 . Registered 18 May 2011

中文翻译：

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恶性、良性和非肿瘤手术患者的连贯感、心理健康以及感知的术前医院和手术相关压力


这项前瞻性、横断面、观察性研究检查了恶性、良性和非肿瘤手术患者的连贯感 (SOC)、心理健康以及术前感知的医院和手术相关压力之间的关联。目的是评估 SOC 与术前压力之间的假定关联，并测试心理健康的统计中介作用。样本由来自不同外科领域的 4918 名患者组成，其中 945 名患有恶性肿瘤，333 名良性肿瘤，3640 名无肿瘤。对于每个子样本，我们进行了简单的中介分析，以测试 SOC 对心理健康介导的术前压力的间接影响。这些模型根据年龄、性别和基本医疗因素进行了调整。患者组在 SOC 和心理健康程度方面没有显着差异（SOC、M [SD]：12.31 [2.59]、12.02 [2.62]、12.18 [2.57]；心理健康 M [SD]：59.26 [24.05 ]、56.89 [22.67]、57.31 [22.87]，分别在恶性、良性和无肿瘤患者中）。无肿瘤患者报告的压力（4.19 [2.86]，M [SD]）显着低于良性肿瘤患者（5.02 [3.03]，M [SD]）和恶性肿瘤患者（4.99 [2.93]，M [SD]）。在所有三种中介模型中，SOC 对压力都有显着的直接影响，较高的 SOC 与较低的压力相关（− 0.3170 [0.0407]，− 0.3484 [0.0752]，− 0.2919 [0.0206]；c' [SE]，p < 0.001分别针对恶性、良性和非肿瘤患者）。在患有恶性肿瘤和无肿瘤的患者中，SOC 对压力显示出较小的间接影响，而这种影响在统计上是由幸福感介导的。较高的 SOC 与较高的幸福感相关，而较高的幸福感又与较低的压力相关。 然而，在良性肿瘤患者中，未发现 SOC 具有显着的间接影响。 SOC 与较低的医院和手术相关压力直接相关，高于心理健康的直接影响和中介影响。由于数据是横截面数据，因此无法得出暗示因果关系的结论。尽管如此，它们表明了重要的关系，可以为治疗方法提供信息，通过专门解决低 SOC 来减少术前应激升高。 ClinicalTrials.gov 标识符：NCT01357694。2011 年 5 月 18 日注册